New prophylactic intraoperative septated circumferential barrier laser in macular surgery

Despite the availability of minimally invasive intraoperative prophylactic sclerotomy-site laser retinopexy and 360-degree laser retinopexy to reduce the incidence of retinal detachment (RD), RD is still prevalent in macular surgery. We investigated the efficacy and safety of a new prophylactic laser retinopexy method, the intraoperative septated circumferential barrier laser (SCBL), to prevent clinically significant RD during complete phacovitrectomy in macular surgery.

Retrospective case-control study.

Six hundred and eighteen consecutive patients who underwent an uncomplicated phacovitrectomy between 2005 and 2011 to treat an epiretinal membrane (ERM) and macular hole (MH) were included.

Three hundred and forty-four patients received SCBL (group 1), and 274 patients did not receive SCBL (group 2). In the SCBL procedure, 1 or 2 rows of circumferential moderate-intensity burns were placed anteriorly to the equator with a subsequent 5-6 septate laser burns made from the circumferential laser marks to the anterior vitreous base perpendicularly at intervals of about 60 degrees.

The SBCL procedure took an additional 208 ± 23.1 seconds in the most recent 47 patients. SCBL was associated with a significant reduction of clinically significant RD (from 2.6% in group 2 to 0% in group 1; p = 0.003). Postoperative complications related to SCBL such as anatomical failure in MH, macular edema, and ERM were not significantly different between the 2 groups (p = 0.738, p = 0.743, and p = 0.914, respectively).

Prophylactic intraoperative SCBL produces a significant benefit by preventing postoperative RD without significant complications in ERM and MH surgery combined with phacoemulsification.